City of Tempe Public Records Request Form

Request is hereby made for the following public records (indicate document name, page numbers, address and permit number where applicable):

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Request is hereby made for the following public records (indicate document name, page numbers, address and permit number where applicable):

Pursuant to A.R.S. §39-121.03, the applicant certifies that said documents: (check one)

Pursuant to A.R.S. §39-121.03, the applicant certifies that said documents: (check one)

Will not be used for a commercial purpose.

Will be used for the following commercial purpose (statement of commercial purpose pricing computation worksheet shall also be completed and attached):

A commercial purpose is defined by A.R.S. §39-121.03 as “the use of public record for the purpose of the sale or resale or for the purpose of producing a document containing all or part of the copy, printout, or photograph for sale, or obtaining of names and addresses from such public records for the purpose of solicitation, or for any purpose in which the purchaser can reasonably anticipate the receipt of monetary gain from the direct or indirect use of such public record.”

A commercial purpose is defined by A.R.S. §39-121.03 as “the use of public record for the purpose of the sale or resale or for the purpose of producing a document containing all or part of the copy, printout, or photograph for sale, or obtaining of names and addresses from such public records for the purpose of solicitation, or for any purpose in which the purchaser can reasonably anticipate the receipt of monetary gain from the direct or indirect use of such public record.”

NOTICE: A person who obtains a public record for a commercial purpose without indicating the commercial purpose or who obtains a public record for a noncommercial purpose and uses or knowingly allows the use of such public record for a commercial purpose or who obtains a public record for a commercial purpose and uses or knowingly allows the use of such public record for a different commercial purpose or who obtains a public record from anyone other than the custodian of such records and uses it for a commercial purpose shall in addition to other penalties be liable to the state or the political subdivision from which the public record was obtained for damages in the amount of three times the amount which would have been charged for the public record had the commercial purpose been stated plus costs and reasonable attorney fees or shall be liable to the state or the political subdivision for the amount of three times the actual damages if it can be shown that the public record would not have been provided had the commercial purpose of actual use been stated at the time of obtaining the records. A.R.S. § 39-121.03(C).

Applicant Information

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Applicant Information

First Name

Last Name

Address

City

State

Zip Code

Phone Numberext.

Email Address

Applicant Full Name

Date

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Email Address

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